Are You a Burned Out Dad?

* First Name:

* Last Name:

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1

How many children do you have?

One

Two

Three

Four or more

2

How often do you feel exhausted regardless of how much rest and sleep you get?

a. Everyday

b. Several times a week

c. Several days in the month

d. Only when I can't sleep

d. I never feel exhausted

3

How often do you feel emotionally and physically exhausted?

a. All the time

b. Often

c. Sometimes

d. Rarely

e. Not at all

4

Do you isolate yourself in relationships, whether with friends, family, or acquaintances?

a. Yes, I withdraw or isolate in my relationships.

b. Most of the time I withdraw and isolate in my relationships.

c. Sometimes, depending on my stress levels or the demands in my life.

d. Rarely do I withdraw and isolate in my relationships.

e. I never withdraw and isolate in my relationships.

5

How often do you snap, use sarcasm, or react annoyed to your children and family?

a. All the time, whenever they are around me!

b. Often, do you know who I live with?

c. Sometimes, when it's justified or I am hormonal.

d. Seldom, only when I'm really stressed out.

e. Never, I am calm and kind all the time.

6

How often do you feel a sense of accomplishment at the end of the day?

a. Always, I feel good about what I get done in a day.

b. Often, I feel good about what I've done in a day.

c. Sometimes, depending on how much is done.

d. Seldom, feeling accomplished is overrated.

e. Never - accomplishment, what's that?

7

How often do you hear positive feedback (eg. "Nice job," "you're a great dad," "thank you," "I appreciate you")?

a. Every day

b. Several times a week

c. On occasion

d. Rarely

e. Never - what is positive feedback?

8

How often are you able to get at least 7 hours of sleep?

a. Every night

b. Most nights

c. Sometimes, it depends on the night

d. Rarely

e. Never

9

How often do you make time for yourself to reset, replenish, and reset?

a. Daily

b. At least once a week.

c. Several times a month.

d. Only on vacation or holidays.

e. Never.

10

Which statement mostly describes the support you receive from family and friends:

a. My family and friends are my rock! They share my burdens and make my life so much better and enjoyable.

b. They help out from time to time, but I can’t lean on them too much.

c. Family and friends are pleasant but they provide very little, if any, support.

d. It’s a mixed bag. Some family and some friends are instrumental in building me up while others do quite a bit to be exact opposite in my life.

e. Destructive. I try to stay as far away as possible and hope my kids never interact with those people either.

11

What is the most stressful part of parenting for you? (optional)

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